Healthcare Provider Details

I. General information

NPI: 1588124218
Provider Name (Legal Business Name): JENNIFER BANNISTER MURPHY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER RENA BANNISTER DO

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 23RD ST STE 8B
ASHLAND KY
41101-2845
US

IV. Provider business mailing address

PO BOX 2379
ASHLAND KY
41105-2379
US

V. Phone/Fax

Practice location:
  • Phone: 606-408-1290
  • Fax: 606-408-6640
Mailing address:
  • Phone: 606-408-9571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberR5155
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number05533
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: